Medical Billing Terms And Definitions

 Medical Billing and Coding is a complex process. If you are a medical billing learner, you have to be some knowledge of medical billing terms which are primarily used in medical coding and billing. I have written down some terms which are mainly utilized. You can remember them; they used to look like professional Medical billers. 

Medical Billing Terms And Definitions

Adjustment

The portion of a medical bill that the doctor or hospital has agreed not to charge the Patient.

Adjudication

The final determination of the problems involves the settlement of an insurance claim.

Aging

Any claims or unpaid insurance that is due above 30 days.

Ambulatory Care

It includes all health services that do not need an overnight hospital/clinic stay.

Ancillary Service

You need services beyond room and board charges, such as laboratory tests, therapy, surgery, etc.

Appeal

A process by which a doctor or the Patient can object to the payer when they conflict with the health plan's decision not to pay for the care provided.

Accounts Receivables (AR) 

It's a term to indicate the outstanding amount of money the hospital or physician is still hoping to get paid.

Assignment of Benefits

Insurance expenses are sent straight to the Patient's doctor or hospital.

Authorization

Acceptance of care is needed before a service is delivered. Pre-authorization may be essential before hospital admission or consideration is given by non-HMO providers.

Self-pay balance

The portion of a patient's invoice the guarantor is legally responsible for paying.

 

Allowed Amount

The maximum amount an insurer will pay for a covered medical service or treatment. You’ll need to pay the difference if a remainder is still owed.